Nearly fifty years ago, a fledgling medical school at an Ivy League university and a time-honored, if fiscally modest community hospital decided to take a risk — opening a Family Medicine residency in 1975 and later a Department of Family Medicine in 1978. The gamble was large; although Rhode Island had historically been a general practice state, the medical school and the hospital were moving into uncharted ground and breaking tradition with both their larger competitors north and south (Harvard and Yale) and with the direction of some of the other newly affiliated Brown hospitals. According to its first Dean, Stanley Aronson, Brown Medical School, then just a "Program" in medicine, was ready to take a chance with this new field, especially since it seemed to hold significant potential for the training of well-educated physicians to meet the compelling needs of the Rhode Island population. Also, like the Department of Community Health, where Family Medicine was originally placed, it did not require the investment in laboratory infrastructure that the new school could little afford. Memorial Hospital of RI (MHRI) was interested in sponsoring Family Medicine because, as the CEO at the time, Mr. Frank Dietz, observed, it was consistent with the hospital’s "history and philosophical bent of primary care, general internal medicine, and prevention." The hospital was founded through an 1894 bequest from a local mill owner to serve the workers of the Blackstone Valley and sat on the grounds of two adjoining estates. MHRI had sponsored a general practice training program until the mid-1960s and wanted to reenter medical education after the affiliation with Brown. Family Medicine appeared to be a natural and logical development.

However, how could one start a Family Medicine residency and department in Rhode Island? There were no faculty, no residents, no teaching practices, and no experience. Family Practice (FP) had begun as an approved specialty only in 1969, and knowledge of the field in the Northeast was sparse. To learn from others, the CEO, along with a leading faculty member from internal medicine, traveled to one of the early FP sites in New Jersey. Meanwhile, the first Family Medicine Division Head and later Dean, Dr. David Greer, visited the US heartland to learn about the new specialty in Kansas City and upper Minnesota.  The zealous founders of the field, the leaders of the new American Academy of Family Physicians (AAFP), were eager to help this Ivy League school make the move and imparted their wisdom.

Another step forward was catching the attention of a leading general practitioner in the Pawtucket area, Dr. John J. Cunningham. Though he may have originally been skeptical, he jumped in wholeheartedly, becoming the first medical director, faculty member, and role model. When he came to MHRI to help start the residency, he brought his long-standing practice – including patients, staff, and records — transforming it into the first Family Care Center. Dr. Cunningham also brought his approach to care, providing endless clinical pearls and helping residents distinguish between what was important and what was not. When the residency opened on July 1, 1975, with seven trainees, the full time faculty consisted of Drs. Greer and Cunningham, Dr. Tom Scaramella, a psychiatrist who had been the residency director at Butler Hospital, Dr. Mary Ann Passero, a pediatrician, and Dr. John Evrard, an OB-Gyn.  A psychologist, Ann DeLancey, joined soon afterward. A few local physicians enthusiastically filled out the first faculty becoming community preceptors. The residency flourished and attracted top candidates from around the US. The class size expanded to 12 by 1977, and to 13 several years later. The first graduates completed the program in 1978 and began a tradition that continues to this day — mostly going into practice within an hour’s drive of the residency.

Family Care Dedication (Sept. 1975). From L to R: Charles Janeway, MD, Dr. Percy Hodgson, John J. Cunningham, MD, David S. Greer, MD, Francis R. Dietz

The next step in the development of Family Medicine at Brown involved the granting of Departmental status and the hiring of the first Department Chair. Both milestones occurred in 1978. The new Department, headed by Dr. Louis Hochheiser, began to expand its range of faculty and activities. The Predoctoral division, whose goal was to teach Brown Medical students the principles of medical care and attract young physicians to the specialty, began in 1979, led by the first Predoctoral director and later Associate Dean for over twenty years, Dr. Stephen Smith. Although it took until 1995 before a required six-week clinical rotation in Family Medicine was mandated at Brown (under the guidance of Dr. Chuck Eaton), multiple courses, electives, and enrichment opportunities have always been offered. FM clerkships (both the standard rotations and the longitudinal integrated variety), now under the direction of Drs. David Anthony and Andrea Arena, receive high marks.

The first researcher, Dr. Larry Culpepper, arrived in 1981 and began the outstanding research tradition that continues to this day. This tradition was strengthened when in 1997 the Brown University Center for Primary Care and Prevention was established at MHRI (in a collaboration between Family Medicine, Internal Medicine and Community Health/Public Health) to improve the health of individuals and communities by promoting research, enriching knowledge, and improving practice in primary care and prevention. Its first FM Director has been Chuck Eaton since 2004, with a cadre of researchers from medicine, public health, medical anthropology, psychology, and epidemiology.

Larry Culpepper and other Family Medicine faculty were also instrumental in starting the collaborative training relationship with FQHC Blackstone Valley Community Health Care (BVCHC), a partnership that lasted 14 years, and expanded to other community health centers in RI. This reflected the Department’s continued commitment to the underserved and to vulnerable populations and the residency trained many future health center clinicians and medical directors.

Global family medicine became a focus with the arrival of the second Chair, Dr. Vincent Hunt, who led the Department to new heights during his tenure between 1986 and 2000. International collaborative educational and research projects have taken place in Russia, Jordan, Qatar, Vietnam, Cambodia, Israel, Greece, Hungary, and the Dominican Republic, Honduras and Kenya.  These projects have involved everything from the establishment of national family medicine training, to health service planning, to providing direct service to the underserved.  Two former residents, Drs. Steve Cumming and Alain Montegut, worked for decades in Vietnam to successfully establish Family Medicine training across the country. The Shoulder to Shoulder partnership in Western Honduras, spearheaded by Dr. Emily Harrison and others has been in place for nearly two decades providing health care, education, nutrition, women’s empowerment, and development to one of the poorest countries in the Western Hemisphere. Work in Kenya with Family Medicine, now led by Dr. Daria Szkwarko with previous long term engagement by Dr. Kim Zeller and others, focuses on helping Kenyan registrars (residents) with their required research projects. 

The Department has continued to develop and mature, taking its place among the major Family Medicine departments and training programs in the country. Fellowship training was added, starting with Maternal and Child Health in 1992 (led by Brian Jack and later Rick Long, and after a hiatus,  reborn under  leadership of Dr. Sue Magee, the current director), followed by the C. Everett Koop Health Policy Fellowship in 2002 (Dr. Sean David), the Leadership Fellowship in 2004 (Dr. Alicia Monroe), and Sports Medicine (Drs. Jeff Manning and Amity Rubeor). Since 2012, there has been a flourishing Global Health Fellowship in the Department, founded by Dr. Fadya El Rayess and now headed by Dr. Daria Szkwarko. The MCH Fellowship moved up to Landmark Hospital in 2017, with partnerships with four health centers. In 2024, the Department launched a fellowship in Primary Care Diabetology, led by Dr. Leonard Bertheau. 

In a type of budding process, several faculty and graduates were instrumental in initiating a residency at a health center in Lawrence, Massachusetts and a Department of Family Medicine at Boston University, starting in 1996.

In 1999, the finishing touches were put on the new Family Care Center (FCC) at MHRI, a state of the art family medicine training center. The new FCC replaced the “clinic” style facility, providing three model practices that now house the 36 residents and over 20 faculty – as well as provide a  base for the successful waves of innovative programs – ranging from chronic care, collaboratives to PCMH, group  integrated behavioral health and risk contracts. 

Family Medicine residency training in RI expanded with the development the Kent Residency 15 years ago – which, after moving twice, found a supportive and stable home at Thundermist West Warwick Community Health Center. It was guided by Dr. Jessica Manyan who was the valiant residency director overcoming multiple hurdles to create an exciting and effective training program.  The residency received Accreditation Council for Graduate Medical Education (ACGME) recognition in 2016 and merged with the Brown Family Medicine Residency, becoming a second site, soon thereafter.  Although Dr. El Rayess, as residency director, took overall responsibility, Dr. Jennifer Buckley (director of Kent FMOB), and Dr. Meghan Grant (first director of the osteopathic curriculum) have been “on the ground” at Thundermist and Kent, ever improving the program. Dr. Arnold Goldberg, the first director of the Kent FM inpatient service, stepped down as Associate Program Director in 2024, and was succeeded by Dr. Caitlin Gillooly. 

The Pawtucket FM residency was based on the classic model of having nearly all clinical services in one site. This model worked for nearly 40 years but Memorial’s fortunes worsened over time and after a series of downturns, it closed its inpatient units, starting with the beloved OB floor in 2017-8.  The clinical needs of patients and training needs of residents shifted to The Miriam Hospital for adult inpatients and Women and Infants, Kent, and Landmark for Maternal and Child Health. With the closure of MHRI Emergency Department on January 1, 2018, the Family Care Center was tasked with handling more urgent needs of the population and opened Express Care within the FCC, facilitates seeing walk-ins and same day needs six days a week. 

Health policy and advocacy have been a critical component of the mission of the Department, with faculty, residents, and staff taking leadership roles in innumerable public forums, committees, and advisory boards, and even helping draft legislation to change state laws. Working closely with the Rhode Island Academy of Family Physicians on its legislative initiatives, we have worked to make our voice heard on issues of importance to our patients and our discipline.  Michael Fine took FM advocacy leadership to the next level when he became the Director the RI Department of Health 2011-2015. A joint RIAFP- FM residency Advocacy Day is now a yearly activity, now directed by Drs. Keith Callahan and Gina La Prova.  The Department has also been extremely active in the Care Transformation Collaborative of RI (CTC-RI), becoming the first academic member more than a decade ago.

In 2022, the Department jumped to a new level under the guidance of Dr. Caroline Richardson – the first female Chair of FM at Brown and the first to have an endowed chair. She took over from Dr. Jeffrey Borkan who served as Chair for 21 years.  

The last 50 years have been impressive – and when you add all the accomplishments of the more than 500 graduates, millions of patients have been impacted through expert FM care,1000s of articles written, 1000s of students trained, and primary care altered for the better through RI, the Northeast, the US, and the globe.  At least 40%-50% of the Family Doctors in RI were trained in the residency program and there are now more than 200 Brown FM faculty, including everyone from associate deans to instructors. 

What will the next 50 years bring?  One can only dream!  

Lists of Founders, Past Residency Directors and Chairs